Improper use of antibiotics: Don’t take the risk!

Improper use of antibiotics is a problem on many levels. It’s easy to get the wrong prescription for an illness if it is improperly diagnosed or if the healthcare provider is trying to keep a patient happy. By taking an antibiotic that isn’t necessary, we increase the problem of Superbugs and even put our own health at risk.

Risks of improper use of antibiotics

Improper use of antibiotics increases risk unnecessarily. Use antibiotics wisely.
Improper use of antibiotics increases risk unnecessarily. Use antibiotics wisely.

Not only is an antibiotic NOT needed for viral illnesses, but taking them when not needed can increase problems.

Risks of antibiotics involve diarrhea, yeast infections, allergic reactions, and more.

Every time we take an antibiotic, we assume the risks associated with the antibiotic. If we have a significant bacterial infection, the risk is warranted. But if we have an infection that the antibiotic will not kill, it is an unnecessary risk.

Dr. Oglesby has a great series on antibiotics, covering general facts on antibiotics (such as how they work), how resistance spreads, and when antibiotics may be needed.

Superbugs

Most of us have heard of superbugs, but there is a misconception about how they work.

Using antibiotics inappropriately can allow bacteria to learn to evade the antibiotic, which makes it ineffective. This means that new antibiotics need to be used to treat infections, which increases the time of illness, the cost of treatment, and the risk of untreatable illnesses. Some bacteria develop resistance to all known treatments, which can lead to death.

“The Last time amoxicillin didn’t work and we had to use something else. Can we use that one again?”

A lot of parents think that if one antibiotic failed with a previous infection, they need a different one. This is not true.

The bacteria develop resistance to an antibiotic. Bacteria can share their genetic material with other bacteria, leading to the quick spread of resistance.

Even someone who has never used an antibiotic can be infected with a resistant bacteria, which makes it harder to treat their infection.

Unfortunately, without a bacterial culture it is impossible to know what the best antibiotic is for any specific infection. We use the type of infection and the bacterial resistance pattern of the area to make the best choice.

It’s not the person that becomes immune to an antibiotic

Very often parents request a different antibiotic because “amoxicillin never works for my family.”

A person does not become immune to a type of antibiotic.

Start with an antibiotic that has a narrow coverage usually

A first line antibiotic is an antibiotic that covers the type of infection that is present, but isn’t so broad that it includes more bacteria than needed. It can also be called narrow-spectrum.

One infection with a superbug might require a strong antibiotic, but the next bacterial infection in the same person might respond well to a first-line treatment, such as amoxicillin.

It’s always wise to start with the first line antibiotic for the type of infection unless a person’s allergic to that antibiotic. It doesn’t matter if it worked the last time or not.

Broad spectrum antibiotics are needed for some serious infections

Remember that broad-spectrum antibiotics that have great killing power can increase the risk of killing the good bacteria that your body needs.

If you have a serious infection, they might be needed. In this case the benefit outweighs the risk.

Each new infection is a new bacteria.

The type of infection will determine the most likely bacteria. A culture from the infection (if possible) will specify exactly what bacteria is the cause and which antibiotics will work.

First line antibiotics are chosen based on type of infection as well as local resistance patterns. Upper respiratory tract bacterial infections tend to use different antibiotics than urinary tract infections or skin infections because different bacteria cause different types of infections.

Allergic reaction

Most people can tolerate antibiotics, but allergic reactions can be serious. It’s not worth the risk if the antibiotic isn’t needed in the first place.

Many people think they’re allergic to an antibiotic when they’re not.

Talk to your doctor about any drug allergies you suspect your child has and why.

Diarrhea

Many kids will get loose stools when they take antibiotics.

Probiotics can help re-establish a healthy amount of good bacteria in the gut and slow the diarrhea most of the time.

Unfortunately there is a type of bacteria commonly called C. diff that can overpopulate after antibiotics and cause severe diarrhea. C. diff causes thousands of deaths every year in adults and children, most often following antibiotic use.

If diarrhea develops during or after antibiotic use, talk to your doctor’s office during regular office hours for advice. If there are signs of dehydration, severe pain, blood in stools, or other concerns you should have your child seen quickly.

Gut flora

Antibiotics kill not only the bacteria causing an infection, but also the “good” bacteria (gut flora) in our bodies.

Our bodies are a habitat for healthy bacteria and yeast. I know this seems unnatural or unhealthy to many people, but we need these bacteria and yeast in a healthy balance.

Gut flora is made of many types of healthy bacteria. These bacteria help us with many functions, such as digestion and weight regulation. Good bacteria make products that lower inflammation in the intestines. They also make neurotransmitters which affect our mood.

Different “good” bacteria can be affected depending on which antibiotic is used.

Yeast infections

As mentioned above, our bodies are an ecosystem of bacteria and yeast. When bacteria are killed off with an antibiotic, it throws off the balance and allows the yeast to overgrow.

Yeast keeps the digestive system healthy and helps our immune system. It can help our body absorb vitamins and minerals from food. Despite what you read online, yeast are very beneficial to us – as long as they remain in healthy balance.

There are a lot of people selling products to treat overgrowth of yeast, which is said to cause all kinds of problems. These types of overgrowth are not recognized as true overgrowth by most physicians, but there are true yeast infections.

Yeast can cause infections of your skin (ringworm), feet (athlete’s foot), mouth (thrush), and penis or vagina (yeast infection). At risk people can develop blood infections with yeast. These can be life threatening. Serious yeast infections tend to occur in diabetics, immunocompromised people and those who were treated with antibiotics.

If you suspect a yeast infection, talk to your physician.

Risk vs benefit

When antibiotics are needed to fight a bacterial infection, it is worth the risk of taking the antibiotic.

The balance flips if you have a common cold – don’t take the risk for something that isn’t needed or beneficial.

Antibiotics do not and will not help treat a cold. Ever.

Don’t try to use an antibiotic to prevent a cold from developing into something else.

Improper use of an antibiotic simply has too many risks and will not help, so there is no benefit.

Prevention is key!

If you’re not sick, you don’t even think about looking for an easy fix for a viral illness.

Use proper handwashing, vaccinate against vaccine preventable diseases, and stay home when sick!

 

Cough Medicines: Which One’s Best?

I get a lot of requests for an over the counter cough suppressant suggestion or a prescription cough medicine for kids so they can sleep. Despite my attempts at educating the family about why I don’t recommend any cough medicines, many parents are upset leaving without a medicine.

I have collected numerous articles that show why I treat cough the way I do. Links are included throughout this blog. Click away to learn more!

First, a little background

Most cough medicines were studied in adults and the dosing for kids was calculated from the adult dosage.

Kids are not small adults. Their bodies handle illness and metabolize drugs differently.

But few studies have been done to show if medicines work at all, and if they do, what the best dose is for kids of various ages and sizes.

In 2008 the FDA stated that toddlers and babies should not use cold and cough medicines.

Drug makers voluntarily changed the labeling of over the counter (OTC) cough and cold products, recommending them only for children aged 4 and older. The American Academy of Pediatrics says there is no reason that parents should use them in children under age 6 because of the risks without benefit.

Despite this, studies show that 60% of parents of children under 2 years have given a cough and cold medicine. Why? In my opinion, they are desperate to help their child and don’t think it is enough risk to not at least try.

Of course I would never recommend giving a child a spoonful of pills.

I know it’s frustrating when your child is up all night coughing. It’s frustrating when my kids and I are up all night coughing.

do you know what we do in my house?

  • Humidify the air of the bedroom (during the dry months)
  • Extra water to drink all day
  • Honey before bedtime in an herbal tea (No honey before 1 year of age!)
  • Encourage cough during the day to help clear the airways
  • Nasal rinse with saline (I love this, but my family is not so keen on it)
  • Sleep with water next to the bed to sip on all night long
  • Back rubs, hugs, kisses, & reminders that it will get better
  • Nap during the day as needed to catch up on lost sleep
  • Watch for signs of wheezing or distress

That’s about it for the cough.

If something hurts, we use a pain reliever like ibuprofen or acetaminophen. We use those only if something hurts, not just because and not for fever without discomfort.

Why don’t I give my family cough medicines?

Because they don’t work.

The OTC options:

Cochrane Review in 2007 was done to look at over the counter cough medicine effectiveness in both children and adults. These reviews look at many studies and analyze the data. Unfortunately there are very few studies, and many were of poor quality because they relied on patient report. In studies that included children, they found:

  • Antitussives were no more effective than placebo for kids. (one study) In adults codeine was no more effective than placebo. Two studies showed a benefit to dextromethorphan, but another study did not, so mixed results.
  • Expectorants had NO studies done in children. In adults guaifenesin compared to placebo did not show a statistically different response. 
  • Mucolytics more effective than placebo from day 4-10 in kids. (one study) In adults cough frequency was decreased on days 4 and 8 of the cough. (Note: I am not sure what OTC mucolytic was studied. I am only aware of pulmozyme and mucomyst, both used by prescription in children with cystic fibrosis.)
  • Antihistamine-decongestant combinations offered no benefit over placebo. (2 studies) One of two studies showed benefit in adults. The other did not.
  • Antihistamine shows no benefit over placebo. (one study) In adults antihistamines did not help either.

Another Cochrane Review in 2012 once again failed to show any real benefits of cough medicines, especially given the risks of side effects.

What about some specific studies on OTC medicines?

I cannot report them all here, but here’s a few:

study comparing dextromethorphan (the DM in many cough medicines), diphenhydramine (AKA Benadryl), and placebo in 2004 showed no difference in effectiveness of controlling cough for sleep. That means the placebo worked just as well as the medicines. Insomnia was more common in those who got dextromethorphan.

Does guaifenesin help? It is thought to thin mucus to help clear the airways. It does not stop the cough. Studies vary in effectiveness and are typically done in adults, but it may be helpful in children over 4 years of age. Do not use combination cough medicines though, for all the reasons above.

In 2007 honey was shown to be a more effective treatment than dextromethorphan or no treatment. Another study in 2012 showed benefit with 2 tsp of honey 30 minutes before bedtime. A side effect of honey? Cavities… Be sure to brush teeth after the honey!

What side effects and other problems are there from over the counter cough medicines?

As stated above, the dosages for children were extrapolated from studies in adults. Children metabolize differently, so the appropriate dosage is not known for children. Taking too much cold medicine can produce dangerous side effects, including shallow breathing and death.

Many cough medicines have more than one active ingredient. This can increase the risk of overdosing. It also contributes to excess medicines given for problems that are not present. For instance if there is a pain reliever plus cough suppressant, your child gets both medicines even if he only has pain or a cough. Always choose medicines with one active ingredient.

Accidentally giving a child a too much medicine can be easy to do. Parents might use two different brands of medicine at the same time, not realizing they contain the same ingredients. Or they can measure incorrectly with a spoon or due to a darkened room. Or one parent forgets to say when the medicine was given and the other parent gives another dose too soon.

And then there’s non-accidental overdose. There is significant abuse potential: One in 20 teens has used over the counter cough medicines to get high. Another great reason to keep them out of the house!

Side effects of cough medicines include:
  • Nausea and vomiting
  • Stomach pain
  • Confusion
  • Dizziness
  • Double or blurred vision
  • Slurred speech
  • Shallow breathing
  • Impaired physical coordination
  • Rapid heart beat
  • Drowsiness
  • Numbness of fingers and toes
  • Disorientation
  • Death, especially in children under 2 years of age and those with too high of a dose

What about prescription cough suppressants?

In 1993 a study comparing dextromethorphan or codeine to placebo showed that neither was better than the placebo. Codeine belongs to a class of medications called opiate analgesics and to a class of medications called antitussives. When codeine is used to reduce coughing, it works by decreasing the activity in the part of the brain that causes coughing. It can make breathing too shallow in children. Codeine has several serious side effects which could be life threatening in children. Combination products with codeine and promethazine (AKA phenergan with codeine) should never be used in children.

The FDA has recommended against the use of cough medicines with codeine or hydrocodone for children for years, but just this month strengthened its position. New labels will now state that they aren’t for use in children under 18 years of age. The label will also warn about misuse adults and list the serious side effects and risks of these opioids.

In my opinion, why use it in older children and adults since it hasn’t been shown to work and we know there are risks?

What about antibiotics for the cough?

I’ve enjoyed following Dr. Christina Johns on Twitter for a lot of great advice like this!

Antibiotics may be used to treat bacterial causes of cough (such as some pneumonia or sinusitis) but antibiotics have no effect on viruses, which cause most coughs.

If your child has a cold, antibiotics won’t help.

Antibiotics won’t make the cough go away faster unless there is bacterial pneumonia.

They won’t prevent the cough from getting worse.

They carry risks.

In summary: over the counter and prescription cough suppressants and antibiotics shouldn’t be used for most coughs.